Drug Interactions between carfilzomib and conjugated estrogens / medroxyprogesterone

GENERALLY AVOID: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), have occurred during treatment with carfilzomib, and concurrent use of hormonal contraception also associated with this adverse effect can potentiate the risk. In clinical trials, the reported incidence of venous thromboembolic events was up to 15.3% with carfilzomib plus lenalidomide and dexamethasone versus 9% with lenalidomide and dexamethasone. In addition, the reported incidence of venous thromboembolic events was up to 10.6% with carfilzomib plus dexamethasone versus 3.1% with bortezomib plus dexamethasone. The incidence of thromboembolic events was 2% with carfilzomib monotherapy.

MANAGEMENT: Hormonal contraception associated with a risk of thrombosis should generally be avoided during use of carfilzomib. Advise female and male patients of reproductive potential to use effective contraception or abstain from sexual activity during treatment with carfilzomib for at least 30 and 90 days, respectively, following completion of therapy. Advise the patient to contact their physician immediately if pregnancy does occur during these times.

MONITOR CLOSELY: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), have occurred during treatment with carfilzomib, and concurrent use of other agents also associated with this adverse effect can potentiate the risk. In clinical trials, the reported incidence of venous thromboembolic events was up to 15.3% with carfilzomib plus lenalidomide and dexamethasone versus 9% with lenalidomide and dexamethasone. In addition, the reported incidence of venous thromboembolic events was up to 10.6% with carfilzomib plus dexamethasone versus 3.1% with bortezomib plus dexamethasone. The incidence of thromboembolic events was 2% with carfilzomib monotherapy.

MANAGEMENT: Caution is advised when carfilzomib is used with other drugs that can increase the risk of thrombosis. Thromboprophylaxis should be considered according to local treatment protocols. Close monitoring for thromboembolic events is recommended in patients with known risk factors (e.g., prior thrombosis, hyperlipidemia, hypertension, smoking) for thromboembolism. Patients should be advised to seek immediate medical attention if they develop symptoms of thromboembolism, such as shortness of breath, chest pain, hemoptysis, or arm or leg swelling or pain.